Eligible Hospital Supporting Documentation: supporting documentation must be uploaded at the time of attestation. New Hampshire Medicaid reserves the right to request additional documentation such as patient volume, or average length of stay, encounter reports.

Year 1: Adopt, Implement, Upgrade Certified EHR Technology

Certified EHR Technology Documentation: all certified modules or EHRs that are available at the EH at the start of the EHR reporting period must be added to the cart on the Office of the National Coordinator Certified Health IT Product List (CHPL) website to generate an accurate CMS EHR Certification ID. EHs must upload a screenshot of the CHPL webpage with the CMS EHR Certification ID at the time of attestation.

Payment Documentation: four years of Medicare Cost Report data are required at the time of attestation. This includes the most current filed hospital fiscal year report (referred to as the base year) and the previous three hospital fiscal year reports.

CMS Submission Receipt: when an EH successfully attests for the Medicare EHR Incentive Program on the CMS website, CMS will provide a submission receipt as proof that the hospital successfully attested. This receipt must be uploaded at the time of attestation.

Average Length of Stay Documentation: the most recently filed Medicare Cost report data for total Inpatient Bed Days (CMS 2552-10,Worksheet S-3, Part 1, Column 8, Line 14) and total Discharges (CMS 2552 10, Worksheet S-3, Part 1, Column 15, Line 14).

Proof of AIU (EHs attesting for a Medicaid incentive payment only): hospitals attesting for a Medicaid incentive payment only must provide proof that the EH has adopted, implemented, or upgraded certified EHR technology. EH’s must provide a signed vendor contract; paid invoice; signed purchase order; or document showing legal contractual obligation (which must be retained for three years following the first payment year); as well as proof of payment such as a bank invoice or credit card slip that matches the invoice. Contracts must be fully executed with signatures from the EH and vendor) and clearly indicate that it represents an EHR system.

Year 2: Meaningful Use (MU)

CMS Submission Receipt: when an EH successfully attests for the Medicare EHR Incentive Program on the CMS website, CMS will provide a submission receipt as proof that the hospital successfully attested. This receipt must be uploaded at the time of attestation.

Average Length of Stay Documentation: the most recently filed Medicare Cost report data for total Inpatient Bed Days (CMS 2552-10,Worksheet S-3, Part 1, Column 8, Line 14) and total Discharges (CMS 2552 10, Worksheet S-3, Part 1, Column 15, Line 14)

Please refer to the Eligible Hospital Payment Worksheet and the Eligible Hospital Eligibility Worksheet posted on the Eligible Hospital webpage for more information on requisite Medicare Cost Report data.

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